Editor's Note:

What’s Your Plan B?

Time is getting awfully tight in the fight to stop NCB; providers must develop options.

• By David Kopf
• Apr 05, 2012

I’m probably going to take some flack for writing this, but I’m looking at the Round Two countdown clock, and I’m feeling a little bit worried when it comes to stopping the bid program. Don’t get me wrong; I’m a pretty optimistic guy, and the industry has a solid alternative program in the market pricing proposal, which could gain significant political traction, but the question is how much traction and how fast? In essence, it all comes down to time.

And when Mick Jagger sang, “Time is on my side,” he couldn’t have possibly been talking about the HME industry. Time is most definitely not on our side. The 60-day bid window has passed its March 30 close, and now the industry simply goes into wait-and-see mode, sweating it out until fall, when CMS announces the single payment amounts for Round Two’s various product categories.

Moreover, it won’t be until Spring 2013 that the contracted suppliers for Round Two are announced, and it won’t be until July 2013 that Round Two is implemented. Of course, these are all “target dates,” according to CMS, but we can pretty much rest assured that the program will probably stick somewhat to this schedule.

That is, unless the industry can stop that schedule, and I’m not so sure that will happen. We have a lot of ground to cover when it comes to getting the Marketing Pricing Program in place. When we last left the fight to get Congress to consider the MPP, the industry was working to have the Congressional Budget Office score the MPP so that it would increase the likelihood of having the program attached to legislation moving through the House or Senate.

And that’s pretty much where the industry currently sits: working to educate lawmakers about the problems with the competitive bidding program; advocating on behalf of the MPP; and urging congress members to push to have the CBO score the bill. That’s not a bad thing — it’s what the industry should be doing. I just worry about the time frame.

As the industry is engaged in this crucial advocacy work, it is doing so as the nation’s government hurls seemingly faster and faster toward an election cycle. The general election happens November 6, and I think it’s fair to ask how much progress can we make between now and then, especially with an increasingly distracted set of lawmakers and staff? Furthermore, what happens after the election, when Capitol Hill’s “dramatis personae” will most likely see some considerable shuffling? How many new relationships must be founded, and how much advocacy work must be re-done after the election?

I admit that this is the nature of the beast when it comes to lobbying on behalf of our industry, but it still undeniably means that we will see delays that will probably result in the industry not making solid headway in support of the MPP until about the time that CMS announces the bid amounts. And, given how hard a fight this has been, I wouldn’t be surprised if the effort to get Congress to support replacing NCB with the MPP doesn’t back right up against CMS’s awarding of Round Two contracts. (And I wouldn’t be surprised if CMS advanced its timetable if it saw the MPP making solid headway, either.)

This is why providers need to develop options. Smart HME business leaders must look at their businesses and develop not only new efficiencies, but new business models that can sustain them if they lose a considerable part of the funding through the competitive bidding process. Whether it's retail sales, or expanding into areas like orthotics and prosthetics, or seeing if subcontracting could actually work in Round Two, providers need to start considering alternate scenarios for their futures. Fighting for the MPP is the right thing to do, but it is not the only thing to do. Make sure you develop a plan B for your business. And a plan C and plan D might not be a bad idea, either.

This article originally appeared in the April 2012 issue of HME Business.